Laser-Assisted Liposuction (LAL) Versus Traditional Liposuction: Systematic Review

Literature Review and Evidence-Based Comparative Analysis of Traditional Suction-Assisted Lipectomy (SAL) vs. Ultrasound-Assisted Liposuction (UAL) Reported Outcomes

BACKGROUND

Over the past two decades, liposuction techniques have significantly evolved. Methods aimed at improving safety, efficiency, and cosmetic outcomes have been developed. Energy-based devices (EBD) that generate heat capable of fragmenting fat and inducing skin retraction are the most advertised and marketed as a possible alternative to invasive surgical skin excision. Third-generation ultrasound-assisted liposuction (UAL), vibration amplification of sound energy at resonance (VASER) is at present employed in approximately 20% of liposuction cases. Whether it has truly advanced the field or offers only a marketing advantage with negligible benefits, or whether any benefits, if present, outweigh the costs, remains a subject of debate. In an evidence-based perspective, the current review is intended to critically analyze reported outcomes of UAL compared to suction-assisted lipectomy SAL.

METHODS AND MATERIALS

A PICO literature search was conducted across the MEDLINE, PubMed, and EMBASE databases RESULTS: Only 5 studies that specifically compared ultrasound-assisted liposuction with traditional liposuction techniques were identified and included in this review.

CONCLUSION

In spite of well-documented clinical efficiency, relative safety, decreased incidence of postoperative anemia, and less physician effort, there are at present little convincing long-term data to confirm UAL superior aesthetic outcomes and skin tightening. Offering this technology to patients with excessive fat or skin flaccidity or redundancy for whom more invasive surgery is indicated, on the promise that it will meet their expectations of optimal body contouring and skin tightening without visible scarring, may be somewhat misleading. 1. UAL is known for its clinical effectiveness, safety, lower rates of postoperative anemia, and reduced physician fatigue. 2. Currently, there are insufficient convincing long-term data to validate that UAL delivers better aesthetic results and skin tightening compared to SAL. 3. UAL should be offered to specific patients to ensure satisfactory results.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Physiochemotherapy alginate-based hydrogel inhibiting lipogenesis through antioxidant and ant-inflammatory effects for obesity treatment

Obesity is strongly associated with hypertension, hyperglycemia, insulin resistance, and other metabolic syndrome symptoms, emphasizing the urgent need for innovative therapeutic strategies. Physiochemotherapy, which combines the advantages of chemical and physical therapies, has attracted significant research interest. However, the precise outcomes and mechanisms of this integrative approach for obesity treatment remain poorly understood. In this study, we developed a physically photothermal nanocomposite hydrogel (termed SDAR) loaded with chemical resveratrol nanoparticles for obesity mitigation. SDAR was synthesized using polydopamine-functionalized sodium alginate, Zn2+, and resveratrol nanoparticles. The resveratrol nanoparticles exhibited a size distribution of 5-15 nm and a minor Zetal potential below 1.3 mV across varying pH conditions. The engineered SDAR hydrogel demonstrated stable photothermal performance with a steady temperature around 44 °C, high biocompatibility, strong antioxidant capacity (antioxidant rate of 93.7 %), and anti-inflammatory properties. In a lipid differentiation model, photothermal SDAR hydrogel administration effectively reduced intracellular reactive oxygen species (ROS) and inflammatory markers by over 50 % in 3T3-L1 preadipocytes. Furthermore, SDAR attenuated CCAAT/enhancer-binding protein beta (C/EBPβ) binding activity to downstream target genes, thereby inhibiting lipogenic differentiation. Collectively, the photothermal-responsive SDAR hydrogel presents a promising physiochemotherapy strategy for obesity treatment by suppressing lipogenesis.

Scarless Enhanced Body Contouring

BACKGROUND

A helium-based plasma device with minimal invasiveness selectively heats tissues via joule heating, ensuring safe external temperatures and eliminating the need to monitor the epidermal temperature.

METHODS

From December 2022 to January 2024, Forty-six patients without prior bariatric surgery, who had localized lipodystrophy and mild-to-moderate skin laxity in various body areas, were enrolled in this prospective work. Liposuction was paired with a helium-based plasma radiofrequency device used for all patients. Data on demographics and postoperative complications were disclosed. A patient evaluation was conducted objectively and subjectively, using an independent plastic surgeon assessment and a patient satisfaction survey, respectively.

RESULTS

Our technique was performed on 40 females (87%) and six males (13%), in various body areas: arm (fourteen cases: 30.4%), neck (ten: 21.7%), thigh (nine: 19.6%), abdomen (seven: 15.2%), back (three: 6.5%), gynecomastia (three: 6.5%), their age ranges from 23 to 57 years, and their body mass index (BMI) ranges from 24 to 34.6 kg/m2. Patients' satisfaction at 6 months after surgery was 82.6% (38) satisfied, 15.2% (7) borderline, and 2.2% (1) unsatisfied. Individual plastic surgeon evaluation was 69.6% (32) excellent, 28.3% (13) good, and 2.1% (1) fair. The overall complications rates were postoperative edema in 22 cases (47.8%), ecchymosis in 11 cases (23.9%), persistent skin laxity in one case (11.1%), mild seroma in three cases (6.5%), pain and tingling in six cases (13%), and mild subcutaneous emphysema in four cases (8.7%).

CONCLUSIONS

Combined liposuction and helium-based plasma radiofrequency device usage are a safe, efficient, and minimally invasive substitute for excisional procedures in non-bariatric patients with localized lipodystrophy and mild-to-moderate skin laxity.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy of Liposuction in the Treatment of Lipedema: A Meta-Analysis

Lipedema, a chronic and painful disorder primarily affecting women without a definitive cure, has traditionally been managed with conservative therapy, notably complete decongestive therapy, across many countries. Recently, liposuction has been explored as a potential surgical treatment, prompting this study to evaluate its effectiveness as possibly the first-line therapy for lipedema. Through extensive literature searches in databases such as CrossRef, Web of Science, PubMed, and Google Scholar up to December 2023, and using the Newcastle-Ottawa Scale for quality assessment, the study selected seven studies for inclusion. Results showed significant post-operative improvements in spontaneous pain, edema, bruising, mobility, and quality of life among lipedema patients undergoing liposuction. However, over half of the patients still required conservative therapy after surgery. Despite these promising results, the study suggests caution due to lipedema's complexity, significant reliance on self-reported data, and limitations of the studies reviewed. Thus, while liposuction may offer symptomatic relief, it should be considered an adjunct, experimental therapy rather than a definitive cure, emphasizing the need for a comprehensive approach to care.

Radiofrequency and pulsed electromagnetic field application following liposuction-Clinical evaluation of performance and safety

OBJECTIVE

With more than 1.5 million performed procedures, liposuction was the second most performed esthetic surgical procedure all over the world in males and in females in the year 2020. The objective of this open-label, evaluator-blinded study was to assess the efficacy and safety of an energy-based device that combines multipolar radiofrequency with pulsed electromagnetic field (PEMF) in patients that underwent liposuction.

MATERIALS AND METHODS

A total of 30 subjects, of whom 24 were females (80%), with a mean age of 48.4 ± 11.0 years (range: 27-69 years) and a mean weight of 69.5 ± 11.7 kg underwent unilateral treatment with radiofrequency and application of PEMF after bilateral liposuction. One month after the last of a total of six weekly treatments, skin elasticity, visco-elasticity and net elasticity, as well as subject reported satisfaction on a 5-point scale ranging from -1 (worse) to 3 (very much improved) and esthetic improvement ranging from 0 (very unsatisfied) to 4 (very satisfied) rated by three independent reviewers were assessed.

RESULTS

Three independent and blinded reviewers rated the improvement of the treated side on average as 1.17 + 0.07 compared with baseline. Subjects were very satisfied with their treatment, with a mean score of 3.24 (0.03) out of 4 at the 1-month follow-up visit. Cutometer measurements showed no significant changes.

CONCLUSION

This study revealed that the subjective satisfaction with the results of the application of RF and PEMF after liposuction is high, while at the same time the esthetic appearance as rated by independent raters improved on the treated side.

Use of Radiofrequency-Assisted Liposuction (BodyTite) for Upper Arms Lifting

BACKGROUND

Body contouring surgery is increasingly requested by patients, both for aesthetic and post-bariatric purposes. There has also been a rapid increase in demand for noninvasive aesthetic treatments. While brachioplasty is burdened by numerous complications and unsatisfactory scars, and conventional liposuction is unsuitable for all patients, nonsurgical arm remodeling performed with radiofrequency-assisted liposuction (RFAL) allows to effectively treat most of patients, regardless of the amount of fat and ptosis of the skin and avoiding surgical excision.

METHODS

A prospective study was conducted on 120 consecutive patients who presented to the author's private clinic and required upper arm remodeling surgery for aesthetic purposes or after weight loss. Patients were classified according to the modified classification of El Khatib and Teimourian. Pre- and posttreatment upper arm circumferences were taken after 6 months of follow-up to assess the degree of skin retraction obtained by treating the arm with RFAL. A satisfaction questionnaire regarding the appearance of the arms (Body-Q upper arm satisfaction) was administered to all patients before surgery and after 6 months of follow-up.

RESULTS

All patients were effectively treated with RFAL, and no cases required conversion to brachioplasty. The average reduction in arm circumference was 3.75 cm at 6 months follow-up, and patients' satisfaction increased from 35 to 87% posttreatment.

CONCLUSIONS

Radio frequency is a valid tool to treat most patients with upper limbs skin laxity, with significant aesthetic results and a high degree of patient satisfaction, regardless of the degree of skin ptosis and lipodystrophy of the arm.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment and Prevention of Umbilical Sagging with Laser-assisted Liposuction: The New Happy Protocol

Sagging of the periumbilical skin, also known as the "sad umbilicus," is one of the most common postoperative complications in liposuction. It is characterized by an increase in the width and decrease in the height of the umbilicus. Technological advances in power-assisted liposuction resulting in skin tightening have been central to improvements in the treatment of sagging skin. Laser-assisted liposuction is a procedure in which a laser fiber induces lipolysis and skin tightening. Laser treatment delivered using a 980-nm diode laser may result in up to 30% skin surface area contraction. The aim of this study was to describe a new technique called the "happy protocol" for the treatment and prevention of the sad umbilicus. The periumbilical region is treated using a 980-nm diode laser set to an output power of 20 W, with a total delivered energy of 5000 J. The developed technique may be applied to correct shape distortions or to create a natural-looking and aesthetically pleasant umbilicus during liposuction. A decrease in the width of the umbilicus followed by an increase in height are observed in the first postoperative days. Patients who were followed up for 7 months postoperatively showed positive aesthetic results. The final outcome was an oval-shaped umbilicus, with increased height and reduced sagging in the periumbilical region.

Efficacy of Cold Tumescent for Prevention of Intraoperative Bleeding in Patients Undergoing Liposuction: A Double-Blind Randomized Controlled Trial-Half-Side Comparison

BACKGROUND

Bleeding, a common intraoperative complication of liposuction, often causes pain and discomfort during recovery. Because of the vasoconstrictive effect of adrenaline in the tumescent solution, bleeding can be reduced; however, reports of postoperative bleeding persist. Cold temperatures also have a vasoconstrictive effect.

OBJECTIVES

This study aimed to determine the efficacy of cold tumescent solution in preventing and reducing intraoperative bleeding.

METHODS

This prospective randomized controlled trial was conducted between June 2018 and June 2019. The liposuction areas in each participant were divided into left and right sides; one side received operative room temperature tumescent solution (25 °C), and the other side received low-temperature tumescent solution (4 °C). The areas of ecchymosis, pain scores, and patient and surgeon satisfaction scores were compared and analyzed.

RESULTS

Ten patients with 36 pairs of liposuction areas were enrolled in the study. Cold tumescent liposuction resulted in a significantly lower lipocrit than was obtained on the standard tumescent side (1.56 ± 0.69 vs 2.92 ± 0.94; P < .001). The ecchymosis area and pain score were significantly lower in the cold tumescent group on days 2, 4, 7, and 14. The satisfaction evaluation scores did not differ between patients and surgeons at 12 months postoperatively.

CONCLUSIONS

The use of cold tumescent anesthesia significantly improved liposuction outcomes by reducing the intraoperative blood loss and the postoperative ecchymosis and pain, with no immediate or short-term complications in low-volume liposuction (<1000 mL) procedures. Furthermore, it generated a standard outcome and good patient satisfaction scores.

LEVEL OF EVIDENCE: 2

High-Quality Lipoaspirate Following 1470-nm Radial Emitting Laser-Assisted Liposuction

BACKGROUND

Laser-assisted liposuction (LAL) has been used to maximize viable adipocyte yields in lipoaspirates, although optimizing tissue processing methods is still a challenge. A high-quality lipoaspirate has been a key factor for extended graft longevity.

OBJECTIVE

To assess the viability and potency of stromal vascular fraction (SVF) cells and adipose-derived stem cells (ASCs) in fat samples from lipoaspirates harvested with a novel 1470-nm diode, radial emitting LAL platform. Two processing methods, enzymatic and nonenzymatic, were compared.

METHODS

Laser-assisted liposuction lipoaspirates harvested from 10 subjects were examined for cell viability after processing by enzymatic or nonenzymatic methods. Isolated SVF cells were cultured with an ASC-permissive medium to assess their viability and proliferation capacity by cell proliferation assay. Flow cytometric analysis with ASC-specific markers, gene expression levels, and immunofluorescence for ASC transcription factors were also conducted.

RESULTS

Lipoaspirates showed high SVF cell viability of 97% ± 0.02% and 98% ± 0.01%, averaged SVF cell count of 8.7 × 10 6 ± 3.9 × 10 6 and 9.4 × 10 6 ± 4.2 × 10 6 cells per mL, and averaged ASC count of 1 × 10 6 ± 2.2 × 10 5 and 1.2 × 10 6 ± 5 × 10 5 cells per mL in nonenzymatic and enzymatic methods, respectively. The ASC-specific markers, gene expression levels, and immunofluorescence for ASC transcription factors confirmed the adipose origin of the cells.

CONCLUSIONS

The laser lipoaspirates provide a high yield of viable and potent SVF cells and ASCs through both nonenzymatic and enzymatic processes. Improved purity of the harvested lipoaspirate and high ASC content are expected to result in extended graft longevity. Furthermore, eliminating enzymatic digestion may provide advantages, such as reducing process time, cost, and regulatory constraints.

1470-nm Radial fiber-assisted liposuction for body contouring and facial fat grafting

Background

Laser‐assisted liposuction using 1470‐nm radial fiber emits light energy preferentially absorbed by water, yielding a rapid and localized contouring and tightening effect, with minimal scarring. When collected under appropriate conditions, extracted fat samples can be exploited as autologous filling material in liposculpturing procedures.

Objectives

To assess the 6‐month contouring efficacy of 1470 radial fiber‐assisted liposuction and the volumetric enhancement effect of the harvested tissue in facial fat grafting.

Methods

Twenty subjects underwent liposuction (BeautiFill, Alma Lasers, Inc.) of lower abdominal or outer thigh fat. In seven subjects, harvested samples were grafted into facial regions. Treatment safety, body weight, blinded evaluator‐assessed aesthetic improvements, and subject‐rated satisfaction were monitored for 6 months. Abdominal and facial fat thickness were assessed by magnetic resonance imaging (n = 5) within 3 months of treatment.

Results

One‐month posttreatment, most subjects ranked improvements good/excellent (88%) and skin tightening satisfactory/very satisfactory (92%), with >70% of subjects providing similar scores 6‐month posttreatment. Blinded evaluators noted improved/very much improved aesthetic appearance (87%). Harvested tissue injected as a facial filler (21.0 ± 5.2 ml) led to a 0.63 ± 0.12 mm increase in facial fat thickness, observed by MRI, within 3 months. Six months postfilling, the majority of subjects (83%) were satisfied with the outcome. All procedures were well‐tolerated.

Conclusions

A single 1470 nm radial fiber‐assisted abdominal and thigh liposuction session provided for effective and durable reduction of adipose tissue deposits, with appreciable skin tightening and aesthetic improvements. The gentle harvesting method yielded viable filler material, which was well‐retained in facial regions for up to 6 months.